Nurse and Social Worker Perceptions of Early Adoption of VA's Nationally Scaled Care Coordination Initiative

Care coordination is increasingly evidenced to improve outcomes for patients with complex conditions. Accordingly, the Veterans Health Administration (VA) is expanding care coordination for ~1.5 million Veterans nationally at the highest risk for hospitalization and mortality. One large nationally mandated initiative, Care Coordination & Integrated Case Management (CCICM), provides a practice framework and structure for local facilities to adopt and accelerate care coordination efforts. We sought to characterize the experiences of lead coordinators (LCs) at VA sites during early adoption of CCICM. LCs expressed a common understanding and believed in the goals of CCICM, with wide agreement that Veterans benefit. The level of buy-in to the framework varied. When local CCICM leaders facilitated a collaborative approach, LCs more often embraced the role. Enthusiasm waned when a directive, top-down approach was taken. Providers often lacked awareness or understanding of CCICM, hindering coordination efforts. System-wide education about goals and potential gains of CCICM needs to be expanded.